右室间隔部起搏患者起搏QRS 波时限与心功能的关系

目的:探讨右室间隔部起搏患者起搏QRS波时限与心功能的关系。方法:回顾性分析植入右室间隔部起搏的双腔起搏器患者(111例),起搏器平均植入时间(4.52±3.65)年,通过常规体表心电图测得完全起搏时QRS波时限分为四组:A组为QRS≤120ms(21例);B组为120ms180ms(26例),行心脏彩色多普勒检查获取左房内径(LAD)、收缩末期左室内径(LVESD)、舒张末期左室内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及LVEF,同时检测患者的血清氨基末端脑肭肽前体(NT-proBNP),分析起搏QRS波时限与以上各指标的关系。结果:D组患者LAD、LVEDD、LVESD、IVST及IVPWT较其他三组明显增大,同时LVEF显著下降,NT-proBNP明显升高,有统计学意义(P<0.05)。同时发现随起搏QRS时限的不断增宽,不同组别的LVEF是依次降低(中位值分别为66.5%、60.3%、52.7%和45.8%),而血清NT-proBNP水平是依次增大(中位值分别为143.7 pg/ml、261.8 pg/ml、599.4 pg/m和971.2 pg/ml)。直线相关性分析示起搏QRS波时限与LAD(r=0.141,P<0.05)、LVEDd(r=0.678,P<0.05)、LVEDs(r=0.439,P<0.05)、IVST(r=0.165,P<0.05)及LVPWT(r=0.189,P<0.05)有显著线性关系,呈正相关。起搏QRS波时限与LVEF负相关(r=-0.684,P<0.05),起搏QRS波时限与NT-proBNP的对数正相关(r=0.368,P=0.029)。结论:对于右室间隔部起搏的双腔起搏患者,起搏QRS波时限是一个可初步判断心脏结构和功能的指标,其起搏QRS波时限延长可能会恶化患者的心脏结构及功能,可结合NT-proBNP进行动态观察,对起搏器植入患者的心功能恶化和心衰的预防有一定的临床实用价值。     

Growth-differentiation factor-15, endoglin and N-terminal pro-brain natriuretic peptide induction in athletes participating in an ultramarathon foot race

Chromosome aberration frequency and lipid peroxidation levels were analysed to investigate their efficacy as biological markers for monitoring the genotoxicity and oxidative damage in Korean chromium (Cr)-exposed workers. Fifty-one Cr-exposed workers and 31 age-matched controls in ten chrome-plating plants were sampled. The Cr level was measured in the workers’ blood and urine, and in the ambient air at the workplaces. The conventional Giemsa staining method and fluorescence in situ hybridization (FISH) technique were used for chromosome aberration analysis. Spectrum green whole chromosome paint specific for chromosome 4 was used in the FISH procedure. As for lipid peroxidation, malondialdehyde (MDA) was measured in the blood plasma as thiobarbituric acid-reactive substances (TBARS). The blood Cr concentration was statistically correlated with both the frequency of chromatid exchange and the total frequency of chromosome/chromatid breaks and exchanges, as detected by the Giemsa staining. Meanwhile, the frequency of translocation, as detected by the FISH technique, was significantly higher in the Cr-exposed workers than in the controls and it correlated with the blood Cr concentration. Although the concentration of MDA, the metabolite of lipid peroxidation, in the exposed workers was higher than that in the controls, no statistically significant correlation between the MDA level and the blood or urine Cr levels was observed. Accordingly, the genotoxicity and oxidative damage (plasma lipid peroxidation) in the Korean Cr-exposed workers were consequential at quite low exposure levels, plus chromosome rearrangement, especially translocation, was clearly evident as a biological response marker for Cr exposure based on a significant positive correlation between the translocations detected by FISH and the Cr in the blood.